Antibiotic Resistance Patterns and Detection of OXA-23 and OXA-48 Genes in Acinetobacter baumannii Isolated from Ventilator Associated Pneumonia
Abstract
Background: Acinetobacter baumannii is one of the important causes of nosocomial infection worldwide. Patients who use ventilator are in high risk of ventilator association pneumonia (VAP) caused by nosocomial pathogens such as A. baumannii. Carbapenem is one of the last lines of antibiotic therapy in MDR A. baumannii infections. Then, carbapenem resistant strains are a very important challenge for physicians. OXA types carbapenemase enzymes are important mechanisms to carbapenem resistance in A. baumannii. The aim of this study was to determine oxa-23 and oxa-48 producing A. baumannii isolated from VAP.
Methods: In this cross-sectional study, 51 sputum specimens from VAP in hospitalized patients in Hazrat-E-Rasul Hospital, Tehran, Iran were used. Antibiotic susceptibility testing was done after identification according to CLSI 2018. DNA extraction was done by boiling assay and oxa-23 and oxa-48 genes were detected by PCR. Thirty- two (63%) A. baumannii were confirmed according to microbiological and biochemical tests.
Results: The highest resistance was observed against Piperacillin, Cefotaxime, Ciprofloxacin and Ceftazidime with 97% antibiotic resistance, and ampicillin/Sulbactam was the most effective antibiotic (78% sensitivity). Generally, 31 isolates of A. baumannii harbored the oxa-23 gene and none of them had oxa-48. The high prevalence of MDR A. baumannii in VAP is a great problem, especially for the nosocomial infection committee in hospitals.
Conclusion: Rapid detection of MDR and carbapenemase producing strains can be the first step in preventing their spread in hospitals.
2. Azimi L, Talebi M, Khodaei F, et al. Comparison of multiple-locus variable-number tandem-repeat analysis with pulsed-field gel electrophoresis typing of carbapenemases producing Acinetobacter baumannii isolated from burn patients. Burns 2016; 42(2):441-5.
3. Armin S, Fallah F, Azimi L, et al. Warning: spread of NDM-1 in two border towns of Iran. Cell Mol Biol (Noisy-le-grand) 2018; 30; 64(10):125-9.
4. Tsakiridou E, Makris D, Daniil Z, et al. Acinetobacter baumannii infection in prior ICU bed occupants is an independent risk factor for subsequent cases of ventilator-associated pneumonia. Biomed Res Int 2014; 2014:193516.
5. Azimi L, Talebi M, Pourshafie MR, et al. Characterization of Carbapenemases in extensively drug resistance Acinetobacter baumannii in a burn care center in Iran. Int J Mol Cell Med 2015; 4(1):46-53.
6. Azimi L, Alaghehbandan R, Mohammadpoor M, et al. Identification of KPC-producing Pseudomonas aeruginosa and Acinetobacter baumannii in a burned infant: A Case Report. J Med Bacteriol 2012; 1:46-9.
7. Babapour E, Haddadi A, Mirnejad R, et al. Biofilm formation in clinical isolates of nosocomial Acinetobacter baumannii and its relationship with multidrug resistance. Asian Pac J Trop Biomed 2016; 6(6):528-33.
8. Ardebili A, Talebi M, Azimi L, et al. Effect of efflux pump inhibitor carbonyl cyanide 3-Chlorophenylhydrazone on the minimum inhibitory concentration of ciprofloxacin in Acinetobacter baumannii clinical isolates. Jundishapur J Microbiol 2014; 7(1):e8691
9. Nowak P, Paluchowska P, Budak A. Distribution of blaOXA genes among carbapenem-resistant Acinetobacter baumannii nosocomial strains in Poland. New Microbiol 2012; 35(3):317-25.
10. Kooti S, Motamedifar M, Sarvari J. Antibiotic resistance profile and distribution of Oxacillinase genes among clinical isolates of Acinetobacter baumannii in Shiraz teaching Hospitals, 2012–2013. Jundishapur J Microbiol 2015; 8(8):e20215.
11. Clinical Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: nineteenth informational supplement M100–S21. CLSI, Wayne, PA. 2018.
12. Lee K, Lim Y S, Yong D, et al. Evaluation of the Hodge test and the imipenem-EDTA double-disk synergy test for differentiating metallo-b-lactamase-producing isolates of Pseudomonas spp. and Acinetobacter spp. J Clin Microbiol 2003; 41:4623-9.
13. Voets GM, Fluit AC, Scharringa J, et al. A set of multiplex PCRs for genotypic detection of extended-spectrum β-lactamases, carbapenemases, plasmid mediated AmpC β-lactamases and OXA β-lactamases. Int J Antimicrob Agents 2011; 37(4):356-9.
14. Fallah F, Abdolghafoorian H, Sadat Sajadi Nia R, et al. Antimicrobial resistance patterns of Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus aureus isolated from patients with nosocomial infections admitted to Tehran Hospitals. Arch Pediatr Infect Dis 2015; 3(4):e32554
15. Royer S, Faria AL, Seki LM, et al. Spread of multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa clones in patients with ventilator-associated pneumonia in an adult intensive care unit at a university hospital. Braz J Infect Dis 2015; 19(4):350-7.
16. Owlia P, Azimi L, Gholami A, et al. ESBL-and MBL-mediated resistance in Acinetobacter baumannii: a global threat to burn patients. Infez Med 2012; 20(3):182-7.
17. Medina-Presentado JC, Seija V, Vignoli R, et al. Polyclonal endemicity of Acinetobacter baumannii in ventilated patients in an intensive care unit in Uruguay. Int J Infect Dis 2013; 17(6):e422-7.
18. Phu VD, Nadjm B, Duy NHA, et al. Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology. J Intensive Care 2017; 19;5:69.
19. Khurana S, Mathur P, Kumar S, et al. Incidence of ventilator-associated pneumonia and impact of multidrug-resistant infections on patient's outcome: Experience at an Apex Trauma Centre in North India. Indian J Med Microbiol 2017; 35(4):504-10.
20. Bagheri-Nesami M, Rezai MS, Ahangarkani F, et al. Multidrug and co-resistance patterns of non-fermenting Gram-negative bacilli involved in ventilator-associated pneumonia carrying class 1 integron in the North of Iran. Germs 2017; 7(3):123-31
21. Mohammadi F, Goudarzi H, Hashemi A , et al. Detection of ISAbaI in Acinetobacter baumannii strains carrying OXA genes isolated from Iranian burn patients. Arch Pediatr Infect Dis 2017; 5(2):e39307.
22. Nowak J, Zander E, Stefanik D, et al. High incidence of pandrug-resistant Acinetobacter baumannii isolates collected from patients with ventilator-associated pneumonia in Greece, Italy and Spain as part of the MagicBullet clinical trial. J Antimicrob Chemother 2017; 72(12):3277-82.
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| Issue | Vol 8 No 3-4 (2019) | |
| Section | Original Articles | |
| Keywords | ||
| Acinetobacter baumannii Carbapenemse Ventilator association pneumonia. | ||
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